The complex relation of complications and long-term satisfaction in breast reconstruction after mastectomy: A comparative clinical study.

Abstract

Autologous breast reconstruction (ABR) and implant-based breast reconstruction (IBR) are techniques that are commonly employed following mastectomy, yet their comparative impact on health-related quality of life (HRQL) remains debated. Although both approaches have demonstrated positive effects, studies regarding the superiority of one technique over another are lacking consensus, possibly owing to variations in complications and revision surgery requirements. We aimed to investigate and compare factors associated with HRQL in both techniques. This retrospective single-center study analyzed complication rates using the Clavien-Dindo classification and BREAST-Q-based patient-reported outcomes in patients undergoing immediate ABR or IBR between 2010 and 2023 at the Medical University of Graz, Austria. Patient- and surgery-related factors were analyzed for statistical correlations with outcomes. Among the 162 included patients, 64 (39.5%) underwent ABR and 98 (60.5%) underwent IBR. ABR patients experienced significantly higher rates of Clavien-Dindo grade I-IIIb complications (p < 0.001). However, ABR patients also reported significantly higher long-term satisfaction with the reconstructed breast (79.5 vs. 62.0; p = 0.001) and sexual well-being (76.4 vs. 58.6; p = 0.008). Given the generally low severity of complications, ABR and IBR emerged as safe procedures, each significantly improving HRQL. In our cohort, ABR was associated with higher early complication rates, yet it demonstrated superior long-term satisfaction. However, reconstruction strategies should be personalized to balance surgical risks with patient-centered long-term outcomes. Autologous and implant-based breast reconstructions after mastectomy are safe and improve quality of life. Autologous reconstruction has more early complications but leads to higher long-term satisfaction and sexual well-being.